Letter to the Editor, Regarding “Covered Carotid Stents”
McDougall et al., in a recent article described the use of a covered stent as an adjunct in the resection of the carotid body tumors (CBT)1. Excision is indicated for most tumors, but the surgery is not risk free and the best results are achieved by specialist team. According to Shamblin’s classification, bigger is the CBT, higher is the risk of cranial nerve and vascular injury. TIA/Stroke rate after CBT excision varies from 0 to 8% in international studies. The incidence of cranial nerve deficit after CBT surgery varies from 11% to 49%, but the incidence of permanent cranial nerve deficit has been quoted less than 1% in international Literature. The internal and external carotid artery injury rate varies from 2 to 13% and from 0 to 32%, respectively2. The intraoperative blood loss is higher for type III (Shamblin Classification) carotid body tumors or with diameter greater than 4 cm and, in these cases, preoperative embolization is indicated. The use of a covered stent during the carotid paraganglioma excision is described in isolated cases. In addition, the use of this additional procedure is possible to increase the rate of early (carotid artery dissection) and late complications (restenosis), and does not modify substantially the risk of intraoperative bleeding (700 ml of blood loss in case 1) because the need for dual antiplatelet therapy and incomplete CBT devascularization. Conversely, it may be useful for previously treating a carotid stenosis to avoid intraoperative embolization during CBT manipulation.
Antonio Bozzani, Vittorio Arici, Attilio Odero
1. McDougall CM, Liu R, Chow M. Covered Carotid Stents as an Adjunct in the Surgical Treatment of Carotid Body Tumors: A Report of Two Cases and a Review of the Literature. Neurosurgery. 2012 Jan 17. DOI: 10.1227/NEU.0b013e31824b131b
2. Sajid MS, Hamilton G, Baker DM; Joint Vascular Research Group. A multicenter review of carotid body tumour management. Eur J Vasc Endovasc Surg. 2007 Aug;34(2):127-30.